Approaches to Immunopathology
Immunopathologic studies can be performed on paraffin or frozen tissue, with comparable sensitivity and specificity, although frozen immunofluorescence is generally considered to be the gold standard. The ISHLT WF allows laboratories to use whatever method they prefer based on their capabilities and individual preferences, but it is critical to have appropriate staining controls.
There are important logistic considerations with immunofluorescence, since the biopsy tissue must not be placed in formalin. Since the frozen tissue is separated from the other pieces examined by routine histology, reviewing the frozen section H&E from this piece should not be overlooked. The specific antibody staining panels differ for each method and the ISHLT WF has outlined required and optional sets of stains for each (see IHC Table and IF Table).
Immunohistochemistry (IHC) for paraffin-embedded tissue and immunofluorescence (IF) for frozen-tissue will be treated separately as they entail different antibody panels and a different mode of interpretation.
Low and High Power Examination
Like routine histology, an algorithmic approach to immunostain interpretation is helpful. An approach based on scanning/low power (x20-40) followed by high power (x200-400) is suggested.
The first low power biopsy assessment helps:
High power examination helps:
The information on the Society for Cardiovascular Pathology's Web Site is provided with the understanding that the Society is not rendering medical advice, or recommendations. You should not rely on any information in the text files, messages, bulletin boards or articles on these pages to replace consultations with qualified health care professionals to meet your individual medical needs.